scholarly journals Rehabilitation in post-COVID patients. A single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Q Villani ◽  
M Villani ◽  
G Halasz ◽  
A Rosi ◽  
M F Piepoli

Abstract   The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients. The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment. In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p<0.005, SMWT admission 146±25 vs 318±18 m, p<0.005) and in clinical complexity (RCS admission 10.9±1.1 vs discharge 5.3, p<0.05). At admission the comparison between Group A vs B has show: 1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005) 2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns) 3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05) After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups: 1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns 2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns) Conclusions Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative. FUNDunding Acknowledgement Type of funding sources: None.

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
GQ Villani ◽  
A Rosi ◽  
D Corbellini ◽  
V Schettino ◽  
A Bosoni ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients. The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3± 11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5± 10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment. In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7 ± 20 vs discharge 72.7 ± 28.6 p <0.005, SMWT admission  146 ± 25 vs 318 ± 18 m, p <0.005) and in clinical complexity  (RCS admission 10.9 ± 1.1 vs discharge 5.3, p< 0.05) Conclusions Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative. Group A vs Group B Group A Group B p pre-rehabilitation hospital stay (days) 31 ± 5 8 ± 2 0.005 RCS admission 10.9 ± 1.1 11.6 ± 1.2 ns BI admission 29.7 ± 20 47.7 ± 19 0.05 SMWT admission (m) 146 ± 25 255 ± 18 0.05 Rehabilitation duration (days) 29.7 ± 12.8 29.6 ± 10.1 ns RCS discharge 5.3 ± 2 6.5 ± 2 ns BI discharge 72.7 ± 28 71.5 ± 22.5 ns SMWT discharge (m) 385 ± 18 410 ± 25 ns RCS rehabilitation complexity scale, BI: Barthel Index, SMWT: six-minute walking test


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Burazor ◽  
DS Spiroski ◽  
J Terzic ◽  
P Otasevic ◽  
R Babic ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) is a class I treatment for cardiovascular disease, still, underutilization of these services remains. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has been present. Purpose and methods We aimed to present the cardiac rehabilitation during COVID 19 times in Belgrade. At the beginning of epidemic in Serbia the number of patients in in-house city program was 70 out of 70 beds, with 200 patients who were scheduled (on the waiting list). Similarly to the other countries, we continued to admit only urgent patients with acute coronary settings. Results Only one PPCI center in Belgrade (2 million inhabitants plus surrounding area; out of five centers) continue to admit COVID-negative patients with STEMI from 13of March to 11 of May, during the first pick of COVID-19 epidemic in Serbia. Out -patients cardiac rehabilitation programs were stopped. The totals of 80 patients (PCR negative) were transferred to exercised based cardiac rehabilitation secondary prevention program during the first pick of epidemic directly from acute hospital. The majority of patients were males in their 50s. All risk factors were noted and patients were with much less risk factors compared to non- epidemic era. Lipid profile was measured. Six minutes walking test was performed at the beginning and exercise plan was made. Unfortunately, exercise based three weeks in- house cardiac rehabilitation was completed in only 1% of patients while others quite the program. Conclusion The COVID-19 pandemic presents a time to highlight the value of home-based models as we search for ways to continue to provide care. Standardization of home based CR models is essential to provide care for a wider range of patients and circumstances in the near future.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Chwyczko ◽  
L Zalucka ◽  
E Smolis-Bak ◽  
I Kowalik ◽  
E Noszczak ◽  
...  

Abstract Background Rehabilitation after LVAD implantation is increasingly used. We developed the novel method of comprehensive rehabilitation starting directly after LVAD implantation. Study group 21 recent LVAD (15 Heart Mate III, 6 HeartWare) recipients (56.2±11.7 yrs, 100% men) were included to 5-week rehabilitation program, which included supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). 6-minute walking test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of rehabilitation program. Results See Table 1. At the end of rehabilitation program, significant increase in 6MWT distance, maximum workload, peak VO2 and upward shift of anaerobic threshold in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitaton. Conclusions Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of 6-minutes walking test distance and cardiopulmonary exercise test results. Moreover, this novel rehabilitation program reduces levels of prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development - STRATEGMED II project


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
EM Martins ◽  
LS Silveira ◽  
GS Ribeiro ◽  
AM Vieira ◽  
ABAO Roque ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Talk test (TT) is an alternative and accessible tool for prescribing and monitoring aerobic training intensity. Although the TT is reliable and valid for cardiorespiratory assessment, its responsiveness to exercise training remains unexplored. Purpose To evaluate the responsiveness of TT in cardiovascular disease (CVD) patients who underwent an exercise training program. Methods Twenty-one CVD patients (61.7 ± 8.4 years) performed an exercise-training program on phase II of cardiac rehabilitation (45-min 3-times a week). The six-minute walk test (6MWT) and TT were done to assess functional capacity at baseline and after 8 weeks. In the individualized TT the treadmill’s speed and/or grade were increased every 2-min, with speed changes based on a reference equation for the 6MWT distance (6MWD). The subjects were asked to read a 38 words standard paragraph at the last 30s of each stage and to answer if they could talk comfortably. Answer options were i) YES (TT+), ii) UNCERTAIN (TT±), or iii) NO (TT-). The first ventilatory threshold (VT1) was identified by two reviewers using the heart rate variability analysis. A paired t-test was applied to analyze the TT duration and 6MWD. The VT1 and TT workload were analyzed by the Wilcoxon test. Spearman correlation was adopted to compare the TT± and VT1 stages. Results Improvement in the VT1 (2.9 ± 1.2 vs 4.4 ± 1.4 min; p < 0.001), duration (12.1 ± 4.4 vs 14.9 ± 5.2 min; p < 0.001), workload at TT- (67.8 ± 48.4 vs 104.5 ± 65.9 w; p < 0.001), and in the 6MWD (471.5 ± 100.3 vs 533.7 ± 92.9 m; p < 0.001) were observed. There was strong correlation between TT± and VT1 in pre (r = 0.613; p < 0.05) and post-rehabilitation (r = 0.678; p < 0.05). Conclusion Talk test performed on a treadmill showed responsiveness after eight weeks of exercise training, being sensitive to the physiological changes provided by the rehabilitation program in CVD patients.


2021 ◽  
pp. 152660282110648
Author(s):  
Zhe Cheng ◽  
Gary B. Rajah ◽  
Jie Gao ◽  
Xiaokun Geng ◽  
Yuchuan Ding

Purpose: Endovascular treatment of atherosclerotic tandem occlusions in acute ischemic stroke (AIS) is a matter of debate. This article reports a single-center experience using an intermediate catheter with microballoon for treatment of tandem occlusions. Methods: A total of 151 AIS patients with large vessel occlusion received endovascular therapy and a consecutive series of patients (n = 26) who suffered from tandem cervical intracranial occlusions were treated using the Passing Extracranial Artery Occlusion by Intermediate Catheter with Expanding Microballoon (PEACE) technique. Intracranial recanalization was achieved by aspiration or stent retriever and then emergency stenting was performed for extracranial internal carotid artery (ICA) lesion. Demographic, clinical characteristics, procedural details of endovascular therapy, and prognosis outcome were assessed. The outcomes of tandem occlusion group were compared with isolated intracranial occlusion group (n = 122) and previous studies. Results: As compared to isolated intracranial occlusion groups, only a few patients suffered from atrial fibrillation (7.7% vs 38.5%, p<0.01) in tandem occlusions group. A larger proportion of patients (61.5% vs 29.5%) had tandem occlusions in which extracranial ICA occlusion was combined with intracranial terminus occlusion in ICA (p<0.01). 46.2% of tandem occlusions patients achieved intracranial recanalization by aspiration alone versus 15.6% in patients with isolated intracranial occlusion (p<0.01). In tandem occlusion patients treated with PEACE, 92.3% achieved successful reperfusion (thrombolysis in cerebral infarct [TICI] ≥2b). The median time from puncture to recanalization was 51 minutes (interquartile range [IQR], 41–66). 67.6% favorable functional prognosis (modified Rankin score [mRS], 0–2) was seen, with 11.5% mortality and 3.8% of symptomatic intracerebral hemorrhage (sICH) at 90 days. These outcomes are all consistent or better than previously reported studies performed for tandem occlusion. Conclusions: Endovascular therapy using the PEACE technique with intermediate catheter and lined expanding microballoon is safe, efficient, and fast in the treatment of atherosclerotic tandem occlusion patients.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Schillaci ◽  
G Stabile ◽  
G Shopova ◽  
A Arestia ◽  
A Agresta ◽  
...  

Abstract Background Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters). Purpose The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL). Methods 16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation. Results Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications. Conclusions Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
Author(s):  
Yi Ren ◽  
Yujin Wang ◽  
Huabao Liu ◽  
Fangzheng Mou ◽  
Xiaofeng Yan ◽  
...  

Abstract Background: A year ago, a new type of coronavirus emerged. Once treated for severe and critical COVID-19 infections, patients are discharged from the hospital for further treatment and rehabilitation. The aim of this study was to evaluate the efficacy and safety of a newly developed comprehensive rehabilitation program based on traditional Chinese medicine (TCM) in the rehabilitation of patients with severe and critical COVID-19.Methods: We recruited a total of 72 patients who had suffered from severe and critical COVID-19 infections and were undergoing rehabilitation in Chongqing, China. A comprehensive rehabilitation program was formulated according to the TCM syndromes of these patients. Specific treatments included oral TCM, Baduanjin, Moxibustion, Acupoint application, and foot baths. Prior to the initiation of treatment, and four weeks after the initiation of treatment, we carried out a range of assessments, including the TCM Syndrome curative effect score, the modified Medical Research Council (mMRC) dyspnea score, the St. George's Respiratory Questionnaire, the Short Form (SF)-36 Quality of Life Scale, and the 6-minute walking test. We also carried out CT scans, serology tests. Statistical analysis was also conducted to evaluate the efficacy and safety of TCM on severe and critical COVID-19 patients.Results: Analysis showed that there were significant differences (P < 0.05) when compared before and after four weeks of TCM treatment, in terms of the TCM syndrome curative effect score, mMRC dyspnea score, St. George's Respiratory Questionnaire score, SF-36 Quality of Life Scale score, and the 6-minute walking test. We also identified significant differences (P < 0.05) between these two timepoints, with regards to the neutrophil ratio, lymphoid cell ratio, lymphocytes, platelets, red blood cells, and hemoglobin. There were no significant differences when compared between the two timepoints with regards to white blood cells and neutrophils (P > 0.05). The efficacy of chest CT scans was 83.9%. Logistic regression showed that the CT scans of patients who did not take the TCM decoction did not improve significantly. The higher a patient’s score on the 6-minute walking test, the higher the probability of no significant improvement on the CT scan.Conclusions: A comprehensive rehabilitation program based on TCM improved a number of clinical parameters in patients suffering from severe and critical COVID-19 infections, including quality of life, clinical symptoms, exercise endurance, and respiratory function. TCM also enhanced lymphocytes, lymphocyte ratio, platelet, red blood cell (RBC) count, and hemoglobin content. TCM also appeared to contribute to the absorption of lung lesions.


Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 085-089 ◽  
Author(s):  
Francesco Uboldi ◽  
Paolo Ferrua ◽  
Daniele Tradati ◽  
Pietro Zedde ◽  
Jim Richards ◽  
...  

Purpose This article verifies the effectiveness of a new brace on patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program. Methods Two groups of 30 patients with PFPS were prospectively and randomly allocated to a rehabilitation protocol, with (group A) or without (group B) the use of a specific brace. All the patients were assessed at 3, 6, and 12 months using the disease-specific Kujala scale and a visual analog scale (VAS) for pain; time to return to sport and patient satisfaction with the brace were also recorded. Results Kujala scale's values showed constant and progressive improvement. The mean score at 6 months was 79.8 ± 6.8 points in group A and 76.8 ± 8.6 in group B, rising at 12 months to 80.9 ± 7.5 in group A and 78.4 ± 8.3 in group B. VAS scores significantly differed (p < 0.05) between the two groups at both 6 and 12 months; the score recorded at 12 months was 0.9 ± 1.3 in the brace-treated group and 1.8 ± 1.6 in the controls. The patients who used a brace showed a quicker return to sports and 75% of the patients in this group were satisfied. Conclusion All the scores improved progressively in both groups. The most significant improvement concerned pain, showing that the brace used in this study may allow a better subjective outcome and a quicker return to sport. Level of Evidence Level II, prospective randomized controlled trial.


2019 ◽  
Vol 17 (3) ◽  
pp. 245-260
Author(s):  
Maria Pąchalska ◽  
Jolanta Góral-Półrola ◽  
Andrzej Mirski ◽  
Celestyna Grzywniak ◽  
Maria Łuckoś ◽  
...  

We evaluated the effectiveness of three different rehabilitation programs for chronic behavioral disorders in traumatic brain injury (TBI) patients with orbito-frontal damage (OFC), incurred from 13 to 15 years prior to enrollment. From among 547 adult patients with severe TBIs treated neurosurgically from 1999 to 2003, 60 were selected for the study, divided into three groups of 20, matched for age and sex. Each group received one of three different rehabilitation protocols. Group A received a comprehensive program with two components: (1) a 6-month early neuropsychological rehabilitation program targeting cognitive deficits, beginning immediately post-injury, and (2) the “Academy of Life” program, with weekly meetings aimed at reducing behavioral disorders in social transactions. Group B received only cognitive rehabilitation, while Group C received only the “Academy of Life” progam. The Frontal Behavioral Inventory (FBInv) was used to assess behavioral disorders at baseline and again after completion of the study. At baseline, all 60 patients still displayed all or most of the common behavioral symptoms characteristic of frontal syndrome. The improvement achieved by group A (the comprehensive program) was significantly better upon completion of the study than that shown by the patients in groups B (cognitive only) and C (social skills only). A comprehensive program of rehabilitation, which combines early neuropsychological rehabilitation of cognitive deficits with the “Academy of Life” program, aimed at improving social skills, proved to be more effective than either of these two components administered without the other


2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Szymczak ◽  
Grzegorz Oszkinis ◽  
Marian Majchrzycki

Objective. The objective of this paper is to compare the impact of supervised walking and resistance training upon the walking distance in PAD patients. Materials and Methods. The examination involved 50 PAD patients at the 2nd stage of the disease according to Fontaine’s scale. The participants were randomly allocated to two groups: one exercising on the treadmill (n=24) and one performing resistance exercises of lower limbs (n=26). Results. The 12-week program of supervised rehabilitation led to a significant increase in the intermittent claudication distance measured both on the treadmill and during the 6-minute walking test. The group training on the treadmill showed a statistically significant increase of the initial claudication distance (ICD) and the absolute claudication distance (ACD) measured on the treadmill, as well as of ICD and the total walking distance (TWD) measured during the 6-minute walking test. Within the group performing resistance exercises, a statistically significant improvement was observed in the case of parameters measured on the treadmill: ICD and ACD. Conclusions. The supervised rehabilitation program, in the form of both walking and resistance exercises, contributes to the increase in the intermittent claudication distance. The results obtained in both groups were similar.


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